The “thirsty dropsy”: Early descriptions in medical and non-medical authors of thirst as symptom of chronic heart failure

A Reanalysis of Historical Figures With Depression and Dropsy

OBJECTIVES

Recent studies suggest a link between chronic kidney disease and brain dysfunctions such as depression and cognitive problems. A review of medieval and early-modern historical figures with aspects of both kidney disease (gout and edema [dropsy]) and depression (melancholia) shows that these conditions were observed together in the past.

MATERIALS AND METHODS

References to the diseases of gout, dropsy, and melancholia were compared in literature on historical subjects. Case studies are reported to detail a previously unremarked com-bination of current kidney disease and depression comorbidity in historical writings.

RESULTS

The poet Boccaccio had gout and melancholia, and some descendants of the Portuguese Avis and Spanish Trastàmara dynasties, known for melancholia and madness, also had gout and dropsy. Historical case series of causes of death for sultans of the Ottoman Empire suggest an association among dropsy, gout, and melancholia.

CONCLUSIONS

In this article, we reviewed the medical research on the comorbidity of kidney disease and depression and shared case studies of historical figures with these conditions and posit not previously noted data supporting comorbidity observations in historical writings.

Belly fat or bloating? New insights into the physical appearance of St Anthony of Padua

Over the centuries, iconographic representations of St Anthony of Padua, one of the most revered saints in the Catholic world, have been inspired by literary sources, which described the Saint as either naturally corpulent or with a swollen abdomen due to dropsy (i.e. fluid accumulation in the body cavities). Even recent attempts to reconstruct the face of the Saint have yielded discordant results regarding his outward appearance. To address questions about the real appearance of St Anthony, we applied body mass estimation equations to the osteometric measurements taken in 1981, during the public recognition of the Saint’s skeletal remains. Both the biomechanical and the morphometric approach were employed to solve some intrinsic limitations in the equations for body mass estimation from skeletal remains. The estimated body mass was used to assess the physique of the Saint with the body mass index. The outcomes of this investigation reveal interesting information about the body type of the Saint throughout his lifetime.

Giovanni Maria Lancisi (1654-1720) and the modern cardiovascular physiology

Giovanni Maria Lancisi (1654-1720) was one of the most important Italian physicians of the modern age. Orphaned of his mother, he spent his early years in the city of Orvieto; when he was 12, his father brought him back to Rome and enrolled him to study medicine at the Sapienza University in Rome. His dedication to study and work soon led him to increasingly important positions. Within a few years, the fame of Lancisi became such that he was appointed the personal physician of three popes. In De Subitaneis Mortibus (1707), he described the pathophysiology of heart diseases, identifying the cause of sudden deaths in structural anomalies of the heart, lungs, and brain. He also wrote about cerebral localizations and first discussed the physiological mechanisms of urine formation and excretion. In 1717, Lancisi described the pathogenesis of malaria and the close correlation between its onset and the swampy waters of the Tiber River, proposing the draining of marshes to eradicate malaria. In the posthumous De Motu Cordis et Aneurysmatibus (1728) he described for the first time heart dilatation and aneurysms of the great vessels, providing a fundamental contribution to the history of cardiovascular physiology. Proof of his interest in medical education is the establishment of an academy and the donation of a library to the hospital, bridging the gap between theory and practice in medical training. Over the centuries, Lancisi's memory has faded, but his work is still relevant for anyone practicing the medical profession.

Thirst and factors associated with frequent thirst in patients with heart failure in Spain

BACKGROUND

Thirst is a troublesome symptom in patients with Heart Failure (HF) and one that might be perceived differently in different countries depending on climate, food and cultural habits. The aims of the study were to describe thirst frequency, duration and intensity and to identify factors associated with frequent thirst in outpatients with HF in a Mediterranean country.

METHODS

Data was collected in a cross-sectional study involving 302 patients diagnosed with HF (age 67±12 years, 74% male, LVEF 43%±14) in Spain on thirst frequency and duration, and thirst intensity by patient self-report (VAS, 0-100 mm). Clinical variables were collected from the medical files. Regression analysis was used to identify factors independently associated with frequent thirst.

RESULTS

Of all the patients, 143 (47%) were frequently thirsty, and their median (25^th and 75^th percentiles) thirst intensity was higher (VAS 50 mm [20-67] vs 7 [0-20], p<.001). Their thirst lasted longer compared to those who never/sometimes were thirsty (p<.001). Less treatment with angiotensin receptor blockers (Odds Ratio [OR] 2.72; 95% Confidence Interval [CI] 1.33-5.58), diuretics >40 mg/day (OR 1.92; 95% CI 1.02-3.64), depression (OR 2.99; CI 1.17-7.62), male gender (OR 1.98; CI 1.08-3.64) and worse New York Heart Association functional class (OR 1.92; 95% CI 1.05-3.52) were independently associated with frequent thirst.

CONCLUSIONS

About half of patients with HF and fluid restriction experienced frequent thirst in a Mediterranean area of Spain, and their thirst duration and intensity were significantly increased. Frequent thirst was associated with demographic, clinical and therapeutic variables. The results may help to identify patients with a higher risk of frequent thirst and might suggest therapeutic changes in order to diminish this troublesome symptom.

"I Miss My Liver." Nonmedical Sources in the History of Hepatocentrism

Hepatocentrism was a medical doctrine that considered the liver the center of the whole human being. It originated in ancient populations (Mesopotamic civilization) and persisted in Western countries until the seventeenth century. Hidden references to hepatocentrism may be found in artistic representations and literary works, from the myth of Prometheus in the Greco-Roman world to the crucifixion iconography throughout the Middle Ages. In the mid-1600s, fundamental discoveries irrefutably demonstrated the central role of the heart in human physiology, which laid the foundations for creating cardiocentrism, shifting the life's center from the liver to the heart. The advent of cardiocentrism immediately restricted the importance given to the liver, favoring the heart in the fine arts. Nevertheless, the liver maintained its importance in literature and popular belief as is evidenced by the widely acclaimed literary texts "Snow White" by the Brothers Grimm, "Moby Dick" by Herman Melville, and "Ode to the Liver" by Pablo Neruda. Our aim is to analyze the most significant artistic representations and literary works that contain references to hepatocentrism, evaluating the changing ideas and beliefs regarding the role and function of the liver throughout history. We want to underline the tight relationship between art and medicine; fine art and literature could be a valuable source for understanding the history of hepatology. (Hepatology Communications 2018; 00:000-000).